1. 2025;28;E215-E218The Tragedy of Chronic Pain and Its Psychosocial Impact: A Commentary on the Case of Luigi Mangione
   Editorial
   James Giordano, PhD.

This commentary explores the tragic case of Luigi Mangione, as detailed in Melanie Thernstrom’s Wall Street Journal article, to address the complex interplay between chronic pain, psychological distress, and systemic inadequacies in healthcare. Chronic pain, as a biopsychosocial phenomenon, profoundly impacts not only physical functionality but also identity, cognition, and behavior, often leading to psychological destabilization and despair. Neurobiological evidence illustrates how chronic pain alters neural structures and functions, amplifying emotional reactivity and impairing judgment. Mangione’s descent into violence exemplifies the detrimental cycle of pain, frustration, and alienation, exacerbated by systemic barriers such as inequitable healthcare access and insurance inadequacies. The discussion highlights the broader ethical implications for pain management, emphasizing the necessity of empathetic engagement, equitable care, and individualized therapeutic approaches. While advances in neurotechnology offer new diagnostic and interventional possibilities, their accessibility and integration into practice raise critical ethical concerns. Additionally, responsible opioid prescribing, informed by nuanced understanding of chronic pain, remains essential to addressing the dual challenges of effective pain relief and the opioid epidemic. This analysis calls for a comprehensive paradigm shift in pain care, integrating biopsychosocial methodologies, healthcare reforms, and ethical innovation. By addressing systemic inequities and prioritizing both high- and low-technology solutions, researchers, clinicians, and policymakers can better support patients and mitigate the far-reaching consequences of unaddressed chronic pain. Ultimately, this tragedy underscores the urgent need for actionable reform to prevent further individual and societal harm.

KEY WORDS: Chronic pain, psychology, healthcare inequity, neurotechnology, neuroethics